3. Adult Reconstruction (Hip & Knee) MCQs

A 55-year-old active woman undergoes a total hip arthroplasty with a ceramic-on-ceramic bearing surface. Three years later, she complains of a newly developed, audible squeaking from the hip with deep flexion. Radiographs are normal. What is the most common cause of this phenomenon?

A 70-year-old active female undergoes total hip arthroplasty (THA) for a displaced femoral neck fracture. Compared to patients undergoing THA for primary osteoarthritis, this patient is at the highest increased risk for which of the following postoperative complications?

During a primary posterior-stabilized total knee arthroplasty, the knee is found to be properly balanced in extension but excessively tight in flexion. Which of the following surgical steps is the most appropriate to resolve this kinematic mismatch?

A 55-year-old male with a metal-on-metal total hip arthroplasty presents with groin pain and swelling 5 years postoperatively. Serum cobalt and chromium levels are significantly elevated. MRI reveals a large, cystic pseudotumor. What is the most appropriate definitive management?

A 58-year-old male presents with severe, end-stage post-traumatic ankle osteoarthritis and is being evaluated for a Total Ankle Arthroplasty (TAA). Which of the following represents an absolute contraindication to proceeding with TAA?

A 23-year-old male presents to the clinic with persistent "snuffbox" tenderness three months after a fall onto his extended wrist. Imaging confirms a non-union of the proximal pole of the scaphoid with early avascular necrosis. The vulnerability of the proximal pole to avascular necrosis is primarily due to the dominant arterial blood supply entering the scaphoid at which of the following locations?

A 68-year-old woman is scheduled for a primary total hip arthroplasty (THA). Preoperative spinopelvic assessment reveals a rigid, flatback deformity with a loss of lumbar lordosis. The pelvis is locked in severe posterior pelvic tilt. To minimize her risk of postoperative dislocation, how should the target acetabular component orientation be adjusted?

A 72-year-old man presents with a painful total knee arthroplasty 3 years after the index surgery. Serum erythrocyte sedimentation rate and C-reactive protein are elevated. Synovial aspiration yields a white blood cell count of 2,500 cells/mcL with 65% polymorphonuclear leukocytes. Which of the following synovial fluid biomarkers has the highest specificity for diagnosing a periprosthetic joint infection (PJI)?

A 58-year-old man presents with progressive groin pain 6 years after a primary metal-on-polyethylene total hip arthroplasty utilizing a titanium stem and a cobalt-chromium modular head. Radiographs are unremarkable, but MRI with metal artifact reduction sequence (MARS) demonstrates a cystic fluid collection around the hip. Serum cobalt levels are significantly elevated. What is the most likely diagnosis?

A 71-year-old woman presents to the emergency department after a fall. She underwent a cementless total hip arthroplasty 10 years ago. Radiographs reveal a periprosthetic fracture around the femoral stem. The fracture line extends just distal to the tip of the stem, the stem is grossly loose, but there is adequate proximal and distal bone stock. According to the Vancouver classification, what is the most appropriate surgical treatment?

During a primary total knee arthroplasty, the surgeon uses a measured resection technique. After making the initial bony cuts, the trial components are placed. The knee is found to be tight in full extension, but the medial and lateral gaps are symmetric and well-balanced in 90 degrees of flexion. What is the most appropriate next step to balance the knee?

A 65-year-old man with a well-functioning right total hip arthroplasty placed 4 years ago presents with 2 days of severe right hip pain, fevers, and chills. He recently recovered from bacterial pneumonia. Aspiration of the hip yields purulent fluid with 85,000 WBCs/mcL. Radiographs show well-fixed components without radiolucencies. What is the most appropriate definitive surgical management?

A 55-year-old woman with severe bilateral developmental dysplasia of the hip (Crowe Type IV) is scheduled for a total hip arthroplasty. Which of the following anatomic abnormalities is expected on the femoral side when compared to a non-dysplastic hip?

A 64-year-old man presents 18 months after a posterior-stabilized total knee arthroplasty with complaints of an audible and palpable "clunk" when transitioning from a sitting to a standing position. Examination reveals a catch at approximately 35 degrees of knee flexion during active extension. What is the primary etiology of this phenomenon?

A 68-year-old woman underwent a ceramic-on-ceramic total hip arthroplasty 2 years ago. She now complains of a squeaking noise coming from the hip during walking, though she denies significant pain. Radiographs show a well-fixed stem and a cup with 55 degrees of inclination and 30 degrees of anteversion. What is the most likely biomechanical cause of the squeaking?

In the recovery room following a complex total knee arthroplasty for a 25-degree fixed valgus deformity, the patient is noted to have a dense foot drop and numbness in the first web space. Pedal pulses are bounding. What is the most appropriate immediate intervention?

A 74-year-old woman is evaluated for a medial unicompartmental knee arthroplasty (UKA). Which of the following preoperative clinical findings is considered an absolute contraindication to a medial UKA?

A 78-year-old woman with osteoporosis is undergoing primary total hip arthroplasty. Preoperative templating demonstrates a Dorr Type C proximal femur, characterized by a wide medullary canal with thin cortices and loss of the medial calcar. Which of the following femoral component types is most appropriate to ensure long-term survivorship in this specific bone morphology?